Following a fall from a horse a 47-year-old woman visited a
physiotherapist, who provided treatment and recommended that she
see a doctor, as the injury would require time off work. The woman
consulted her GP and stated that she was experiencing considerable
pain and discomfort in her right leg and hip. The GP observed the
woman's movement but did not undertake a physical examination. He
prescribed a painkiller and an anti-inflammatory and told her to
continue with physiotherapy. The woman consulted the GP on two
further occasions and then sought a second opinion from another GP,
who arranged an X-ray. The X-ray indicated a fractured neck of
femur, and the woman was admitted to hospital for surgery.

The woman complained that her GP did not adequately assess her hip
and did not consider a fracture injury, leading to a delay in her
treatment and subsequent recuperation.

The GP's notes contained no evidence that a history of the injury
or any previous injuries was obtained, or that a standard physical
examination was carried out or the injury site viewed. It was held
that the GP breached Rights 4(1) and 4(2) by failing to
appropriately examine and diagnose the fractured hip on three
occasions, or to refer the patient for an X-ray or to a specialist.
The Commissioner's expert advisor indicated that the GP lacked
knowledge in the area of hip fractures (in particular with regard
to weight-bearing ability). At the first consultation the GP should
have referred the patient for an X-ray to exclude bony injury, and
when after two weeks there was little improvement, he should have
considered referral to a specialist.

The GP accepted the Commissioner's findings and confirmed that he
would undertake further medical education in relation to this type
of fracture.